Advances in targeted prostate biopsy techniques

袁海燕 吕杨 陆健美 顾峰

doi:10.16098/j.issn.0529-1356.2026.01.006

PDF(838 KB)

Acta Anatomica Sinica ›› 2026, Vol. 57 ›› Issue (1) : 36-41. DOI: 10.16098/j.issn.0529-1356.2026.01.006

Robotics and Surgical Navigation Column

Advances in targeted prostate biopsy techniques

YUAN Hai-yan, LÜ Yang, LU Jian-mei, GU Feng^*

Author information +

History +

Abstract

Transrectal ultrasound (TRUS)-guided biopsy is currently recognized as one of the main methods for prostate cancer diagnosis, however, it has shortcomings such as missing clinically significant prostate cancer and overdetecting clinically insignificant prostate cancer. Multiparametric magnetic resonance imaging (mpMRI) is an important imaging method for diagnosing prostate diseases, which can detect and localize prostate cancer lesions, thus being applicable for guiding targeted biopsy. At present, there are mainly three commonly used techniques for mpMRI-guided targeted biopsy, cognitive fusion, MRI-TRUS image fusion, and MRI-directly guided biopsy. This article elaborates on the application value of MRI and TRUS fusion navigation in guiding prostate targeted biopsy from the aspects of the value of MRI in prostate cancer diagnosis, the application of MRI-TRUS fusion navigation technology in prostate biopsy, and the current problems of fusion navigation and future prospects.

Key words

Prostate cancer / Biopsy / Fusion imaging / Magnetic resonance imaging / Ultrasound / Human

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

YUAN Hai-yan, LÜ Yang, LU Jian-mei, GU Feng. Advances in targeted prostate biopsy techniques[J]. Acta Anatomica Sinica. 2026, 57(1): 36-41 https://doi.org/10.16098/j.issn.0529-1356.2026.01.006

References

［1］Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries［J］. CA Cancer J Clin, 2021, 71(3): 209-249.

［2］Lee J, Song W. Oncological outcomes of partial gland ablation using high-intensity focused ultrasound after additional confirmatory transperineal mapping biopsy in men with prostate cancer［J］. Biomedicines, 2024, 12(11): 2487.

［3］Ahmed HU, El-Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study［J］. Lancet, 2017, 389(10071): 815-822.

［4］Moldovan PC, Van den Broeck T, Sylvester R, et al. What is the negative predictive value of multiparametric magnetic resonance imaging in excluding prostate cancer at biopsy? a systematic review and meta-analysis from the European Association of Urology Prostate Cancer Guidelines Panel［J］. Eur Urol, 2017, 72(2): 250-266.

［5］deSouza NM, Riches SF, Vanas NJ, et al. Diffusion-weighted magnetic resonance imaging: a potential non-invasive marker of tumour aggressiveness in localized prostate cancer［J］. Clin Radiol, 2008, 63(7): 774-782.

［6］Mortezavi A, Märzentdorfer O, Donati OF, et al. Diagnostic accuracy of multiparametric magnetic resonance imaging and fusion guided targeted biopsy evaluated by transperineal template saturation prostate biopsy for the detection and characterization of prostate cancer［J］. J Urol, 2018, 200(2): 309-318.

［7］Wang Y, Huan Y, Ren J. Interpretation of prostate imaging-reporting and data system version 2.1 (PI-RADS v2.1) and comparison with version 2.0［J］. International Journal of Medical Radiology, 2019, 42(6): 712-716. (in Chinese)

汪洋，宦怡，任静. 前列腺影像报告与数据系统2.1版（PI-RADS v2.1）：解读与比较［J］. 国际医学放射学杂志, 2019, 42(6): 712-716.

［8］Dell’Oglio P, Stabile A, Soligo M, et al. There is no way to avoid systematic prostate biopsies in addition to multiparametric magnetic resonance imaging targeted biopsies［J］. Eur Urol Oncol, 2020, 3(1): 112-118.

［9］Park KJ, Choi SH, Kim MH, et al. Performance of prostate imaging reporting and data system version 2.1 for diagnosis of prostate cancer: a systematic review and meta-analysis［J］. J Magn Reson Imaging, 2021, 54(1): 103-112.

［10］Connor MJ, Gorin MA, Eldred-Evans D, et al. Landmarks in the evolution of prostate biopsy［J］. Nat Rev Urol, 2023, 20(4): 241-258.

［11］Lenfant L, Beitone C, Troccaz J, et al. Learning curve for fusion magnetic resonance imaging targeted prostate biopsy and three-dimensional transrectal ultrasonography segmentation［J］. BJU Int, 2024, 133(6): 709-716.

［12］Kongnyuy M, George AK, Rastinehad AR, et al. Magnetic resonance imaging-ultrasound fusion-guided prostate biopsy: review of technology, techniques, and outcomes［J］. Curr Urol Rep, 2016, 17(4): 32.

［13］Zhang F, Huang HF, Zhang SJ, et al. Progress in the clinical application of prostate biopsy［J］. Journal of Modern Urology, 2023, 28(3): 261-264. (in Chinese)

张帆，黄海锋，张胜捷，等. 前列腺穿刺活检的临床应用进展［J］. 现代泌尿外科杂志, 2023, 28(3): 261-264.

［14］Wegelin O, Exterkate L, van der Leest M, et al. The FUTURE trial: a multicenter randomised controlled trial on target biopsy techniques based on magnetic resonance imaging in the diagnosis of prostate cancer in patients with prior negative biopsies［J］. Eur Urol, 2019, 75(4): 582-590.

［15］Hanske J, Risse Y, Roghmann F, et al. Comparison of prostate cancer detection rates in patients undergoing MRI/TRUS fusion prostate biopsy with two different software-based systems［J］. Prostate, 2022, 82(2): 227-234.

［16］Wei JT, Barocas D, Carlsson S, et al. Early detection of prostate cancer: AUA/SUO guideline part Ⅱ: considerations for a prostate biopsy［J］. J Urol, 2023, 210(1): 54-63.

［17］Siddiqui MM, Rais-Bahrami S, Turkbey B, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer［J］. JAMA, 2015, 313(4): 390-397.

［18］Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-targeted or standard biopsy for prostate-cancer diagnosis［J］. N Engl J Med, 2018, 378(19): 1767-1777.

［19］D’Agostino D, Casablanca C, Mineo Bianchi F, et al. The role of magnetic resonance imaging-guided biopsy for diagnosis of prostate cancer; comparison between FUSION and “IN-BORE” approaches［J］. Minerva Urol Nephrol, 2021, 73(1): 90-97.

［20］Ahdoot M, Wilbur AR, Reese SE, et al. MRI-Targeted, systematic, and combined biopsy for prostate cancer diagnosis［J］. N Engl J Med, 2020, 382(10): 917-928.

［21］Hugosson J, Månsson M, Wallström J, et al. Prostate cancer screening with PSA and MRI followed by targeted biopsy only［J］. N Engl J Med, 2022, 387(23): 2126-2137.

［22］Oderda M, Marra G, Albisinni S, et al. Accuracy of elastic fusion biopsy in daily practice: results of a multicenter study of 2115 patients［J］. Int J Urol, 2018, 25(12): 990-997.

［23］Rouvière O, Puech P, Renard-Penna R, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study［J］. Lancet Oncol, 2019, 20(1): 100-109.

［24］Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer–2020 update. Part 1: screening, diagnosis, and local treatment with curative intent［J］. Eur Urol, 2021, 79(2): 243-262.

［25］Cool DW, Zhang X, Romagnoli C, et al. Evaluation of MRI-TRUS fusion versus cognitive registration accuracy for MRI-targeted, TRUS-guided prostate biopsy［J］. AJR Am J Roentgenol, 2015, 204(1): 83-91.

［26］Turkay R, Inci E, Yildiz O, et al. Cognitive versus magnetic resonance-ultrasound fusion prostate biopsy: which one is worthier to perform?［J］. Ultrasound Q, 2020, 36(4): 345-349.

［27］Watts KL, Frechette L, Muller B, et al. Systematic review and meta-analysis comparing cognitive vs. image-guided fusion prostate biopsy for the detection of prostate cancer［J］. Urol Oncol, 2020, 38(9): 734.e19-734.e25.

［28］Pirola GM, Castellani D, Orecchia L, et al. Transperineal US-MRI fusion-guided biopsy for the detection of clinical significant prostate cancer: a systematic review and meta-analysis comparing cognitive and software-assisted technique［J］. Cancers (Basel), 2023, 15(13): 3443.

［29］Ho K, Zhu D, Gupta K, et al. Performance of cognitive vs. image-guided fusion biopsy for detection of overall and clinically significant prostate cancer in a multiethnic population［J］. Urol Oncol, 2024, 42(2): 29.e1-29.e8.

［30］Wysock JS, Rosenkrantz AB, Huang WC, et al. A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial［J］. Eur Urol, 2014, 66(2): 343-351.

［31］Lee DJ, Recabal P, Sjoberg DD, et al. Comparative effectiveness of targeted prostate biopsy using magnetic resonance imaging ultrasound fusion software and visual targeting: a prospective study［J］. J Urol, 2016, 196(3): 697-702.

［32］Zheng T, Bi K, Tang Y, et al. Cognitive fusion-targeted biopsy versus transrectal ultrasonography-guided systematic biopsy: comparison and analysis of the risk of Gleason score upgrading［J］. Int Urol Nephrol, 2024, 56(3): 981-988.

［33］Kaufmann S, Russo GI, Bamberg F, et al. Prostate cancer detection in patients with prior negative biopsy undergoing cognitive-, robotic- or in-bore MRI target biopsy［J］. World J Urol, 2018, 36(5): 761-768.

［34］Costa DN, Goldberg K, Leon AD, et al. Magnetic resonance imaging-guided in-bore and magnetic resonance imaging-transrectal ultrasound fusion targeted prostate biopsies: an adjusted comparison of clinically significant prostate cancer detection rate［J］. Eur Urol Oncol, 2019, 2(4): 397-404.

［35］Kılıç M, Acar Ö, Vural M, et al. Pathological accuracy in prostate cancer: single-center outcomes of 3 different magnetic resonance imaging-targeted biopsy techniques and random systematic biopsy［J］. Turk J Urol, 2022, 48(5): 346-353.

［36］Arsov C, Rabenalt R, Blondin D, et al. Prospective randomized trial comparing magnetic resonance imaging (MRI)-guided in-bore biopsy to MRI-ultrasound fusion and transrectal ultrasound-guided prostate biopsy in patients with prior negative biopsies［J］. Eur Urol, 2015, 68(4): 713-720.

［37］Bass EJ, Pantovic A, Connor MJ, et al. Diagnostic accuracy of magnetic resonance imaging targeted biopsy techniques compared to transrectal ultrasound guided biopsy of the prostate: a systematic review and meta-analysis［J］. Prostate Cancer Prostatic Dis, 2022, 25(2): 174-179.

［38］Falagario UG, Pellegrino F, Fanelli A, et al. Prostate cancer detection and complications of MRI-targeted prostate biopsy using cognitive registration, software-assisted image fusion or in-bore guidance: a systematic review and meta-analysis of comparative studies［J］. Prostate Cancer Prostatic Dis, 2024, 28(2): 270-279.

［39］Kaneko M, Medina LG, Lenon M, et al. Transperineal vs transrectal magnetic resonance and ultrasound image fusion prostate biopsy: a pair-matched comparison［J］. Sci Rep, 2023, 13(1): 13457.

［40］Uleri A, Baboudjian M, Tedde A, et al. Is there an impact of transperineal versus transrectal magnetic resonance imaging-targeted biopsy in clinically significant prostate cancer detection rate? a systematic review and meta-analysis［J］. Eur Urol Oncol, 2023, 6(6): 621-628.

［41］Hu JC, Assel M, Allaf ME, et al. Transperineal versus transrectal magnetic resonance imaging-targeted and systematic prostate biopsy to prevent infectious complications: the PREVENT randomized trial［J］. Eur Urol, 2024, 86(1): 61-68.

［42］Bryant RJ, Marian IR, Williams R, et al. Local anaesthetic transperineal biopsy versus transrectal prostate biopsy in prostate cancer detection (TRANSLATE): a multicentre, randomised, controlled trial［J］. Lancet Oncol, 2025, 26(5): 583-595.

［43］Bhattacharya I, Khandwala YS, Vesal S, et al. A review of artificial intelligence in prostate cancer detection on imaging［J］. Ther Adv Urol, 2022, 14: 17562872221128791.

［44］Bi WL, Hosny A, Schabath MB, et al. Artificial intelligence in cancer imaging: clinical challenges and applications［J］. CA Cancer J Clin, 2019, 69(2): 127-157.

［45］Rebez G, Barbiero M, Simonato FA, et al. Targeted prostate biopsy: how, when, and why? a systematic review［J］. Diagnostics (Basel), 2024, 14(17): 1864.